Medicare FAQ -1

Everybody accept Medicare is Medical billing. Here are some tips.
  1. What is the Medicare Summary Notice(MSN)? (04/01/04)


    The MSN, a statement Medicare sends to beneficiaries, summarizes all of your inpatient and outpatient claims information processed by the Medicare Contractor over a 31-day period.


  2. How long should I wait before contacting the Medicare carrier to check on the status of a claim? (08/16/07)


    If you are not due a payment check from Medicare, your Medicare Summary Notices (MSN) will now be mailed to you on a quarterly basis. You will no longer receive a monthly statement in the mail for these types of MSNs. You will now receive a statement every 90 days summarizing all of your Medicare claims. You may receive a bill from your provider before you receive an MSN. You may not be able to wait for your MSN before your payment to your provider is due. If you have any questions about the bill from your provider, you should call your provider.


  3. What is a "participating provider"? (04/01/04)


    Participating physicians are health care providers that have entered into a contract with the Medicare Part B program. The contract states he/she must accept the Medicare Part B approved amount as payment in full for services provided. Medicare Part B will usually pay 80% of the approved amount. The remaining 20%, called coinsurance, is your responsibility. Most Medicare supplement insurance plans will help pay the 20%.


  4. What if a provider does not accept assignment of a Medicare claim?

    (01/27/05)
    Physicians who do not accept assignment may charge more than Medicare's approved amount but not more than the limiting charge. They also may collect full payment directly from the patient at the time of service. Medicare then pays you 80% of the approved amount, less any unmet portion of the Part B deductible. In Minnesota, the Minnesota Care Law requires doctors to bill at Medicare's allowed charge. This law applies only for Minnesota residents who receive services from a doctor in Minnesota.


  5. What is coinsurance? (04/01/04)


    Coinsurance represents the difference between the Medicare approved amount and the Medicare payment. The patient is responsible for paying the coinsurance amount. If a patient has supplemental insurance, it may help pay this amount. It is 20% of the approved amount.


  6. What is the difference between Medicare and Medicaid? (04/01/04)


    Medicare is a federal health insurance program for the elderly and disabled. Medicaid is a medical assistance program jointly financed by the state and federal governments for eligible low-income individuals. Medicaid does restrict eligibility based on income and assets.


  7. How do I sign up for Medicare? (04/01/04)


    If you are already receiving Social Security payments when you turn 65, you will automatically receive your Medicare card in the mail. The card will show your entitlement to Parts A & B and the effective dates of each. If you do not want Part B, follow the instructions that come with the card to cancel it.

    If you are not receiving Social Security payments, you may have to apply for Medicare. Please check with the Social Security Administration office at (800) 772-1213 for more information. If you must file for Medicare benefits, you should do so three months before you turn 65.


  8. How do I replace a lost or stolen Medicare card? (04/01/04)


    To replace your card, you should contact the Social Security Administration. You may either visit them at the field office nearest your home or contact them through their toll-free number, (800) 772-1213. To find the Social Security Administration office closest to you, check the government pages of your telephone directory under United States, Social Security Administration.


  9. How do I update my permanent address with Medicare Part B?

    (01/27/05)
    Contact your Social Security Administration office at 1-800-772-1213. The SSA maintains and updates your Medicare Part B enrollment file, including your address. Once you have notified the office of the change, you may also want to notify Medicare Part B, especially if you are waiting for claims to be resolved. You can contact Medicare Part B at 1-800-MEDICARE (1-800-633-4227)


  10. When can I return to fee-for-service Medicare after being in a managed care plan? (04/01/04)


    You can leave a managed care plan at any time to join another plan or to return to fee-for-service Medicare.


  11. May I receive services from a provider/supplier that are not covered by Medicare? (04/01/04)


    Yes. A physician may provide services to a beneficiary even if it is not a Medicare benefit. A provider does not have to bill Medicare for any service that is not a benefit. You may, however, ask if your provider will submit a claim to Medicare for denial before billing you for the service.


  12. Who do I contact if I have a complaint about quality of care? (04/01/04)


    Every state has a Quality Improvement Organization to address quality of care issues. Please contact the Quality Improvement Organization in your area.


  13. Will Medicare pay for a routine yearly physical examination? (04/01/04)


    No. Medicare medical insurance does not cover the cost of routine physical exams by your physician. Medicare will also not cover any test related to the routine physical. You are responsible for the payment of these services.


  14. How long does a provider have to submit a claim? (12/31/07)


    Claims must be filed with Medicare by the end of the calendar year following the year in which the services were provided.

    Service DatesDate by which Claim Must Be Filed
    10-01-05 through
    09-30-06
    12-31-07
    10-01-06 through
    09-30-07
    12-31-08
    10-01-07 through
    09-30-08
    12-31-09

    If providers submit an assigned claim 12 months or more after the date of service, their reimbursement may be reduced by 10%. Failure to submit a claim on time may result in the claim being denied. The patient is only responsible for 20% of the amount that Medicare would have approved for the service.

  15. What is a limiting charge? (04/01/04)


    When a doctor does not accept assignment, there are limits on the amount he or she can charge you for most services. The doctor is allowed to charge 115 % of what Medicare approves. This is referred to as the limiting charge.


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